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Laser Hemorrhoidoplasty: Experience at Aga Khan University Hospital

Abdallah Abdulkarim, Misoi Brian, Gathege Daniel

Aga Khan University Hospital​

Correspondence to: Dr. Abdallah Abdulkarim; Email: abdulkarim.abdallah@aku.edu

Abstract

Background: Hemorrhoidal disease is the commonest benign anal condition diagnosed in the outpatient setup. Interventional treatment options range widely, from office-based procedures to hemorrhoidectomy. Laser technology increasingly is in use in the field of proctology. We present our index clinical outcomes following laser haemorrhoidoplasty (LHP). Methods: Retrospective cross-sectional study of 21 consecutive patients who underwent LHP between 2015 and 2018 under a single surgeon. Their outcomes were compared with a group of patients who underwent the standard open hemorrhoidectomy over the same period of time. Results: Postoperatively, 85.7% of patients post-LHP had a better pain score (mild) compared with66.7% in the open hemorrhoidectomy group. The mean operative time in minutes was shorter for LHP, 29.67±17.50 versus 39.20±20.77 in the open group. Duration of hospital stay in days between the two groups were similar; LHP group median=1(1–3), open group median =1(1–3). Rates of infection, recurrence and urinary complications were however higher in the laser group, 4.8%, 9.5% and 9.5% respectively compared with the open hemorrhoidectomy group that were 0%, 6.7% and 6.7 % respectively. Both groups had no reported cases of stool or flatus incontinence. Conclusion: Laser haemorrhoidoplasty is associated with reduced pain scores and shorter operative time than open hemorrhoidectomy. Duration of hospital stay was similar in both groups. The rate of complications was high in the study group.

 

Keywords: Laser haemorrhoidoplasty, Pain score, Complications, Open hemorrhoidectomy

Ann Afr Surg. 2020; 17(2): 76-79

DOI: http://dx.doi.org/10.4314/aas.v17i2.8

Conflicts of Interest: None

Funding: None

© 2020 Author. This work is licensed under the Creative Commons Attribution 4.0 International License.

Introduction

Hemorrhoidal disease is a common presentation at surgical outpatient clinics; estimated worldwide prevalence is between 2.9%and27.9% (1). Its management is associated with significant healthcare related costs (2). Hemorrhoidal disease can be classified as internal or external, depending on the site of origin in relation to the dentate line. Internal hemorrhoids are further sub-classified from grade 1 to 4, depending on degree of prolapse and ease of reduction (3,4).

Laser energy is a novel technique that in increasing use in benign anal conditions (5). Probes are used to produce short, high-energy pulses of light that are transformed into heat energy when absorbed by surrounding tissues. Clinically, de-arterialization may be done with or without mucopexy, or with the use of Doppler assistance. When compared with laser hemorrhoidoplasty and other treatment modalities, conventional hemorrhoidectomy is associated with increased operative time, postoperative pain and duration of hospital stay (6, 7). Data are scarce on outcomes and complications following laser use in management of symptomatic hemorrhoids in Africa.  We present our early experiences with LHP at a teaching hospital and compare its outcomes with the standard of care.

 

Materials and Methods

This is a retrospective single center observational study of 21 consecutive patients who underwent laser haemorrhoidoplasty under one surgeon from 2015 to 2018. We compared their outcomes with 15 patients who underwent open hemorrhoidectomy over the same period. Patients were evaluated at the clinic and booked for surgery if symptoms were refractory to conservative treatment. Both surgical options were offered pre-operatively and informed consent obtained. Intra-operatively, patients were placed in lithotomy position and examined under anesthesia to confirm columns involved and degree of severity based on Goligher’s classification.

Patients undergoing laser hemorrhoidoplasty had a mu